Anoka-Hennepin offering parent-child interaction therapy

Published April 7, 2012 at 12:01 am

A month before Jessica Oberbroeckling began the Anoka-Hennepin School District’s Parent Child Interaction Therapy (PCIT), the young mother had a couple of appointments with an adoption agency to talk about giving her two-year-old son, Nolan, up for adoption.
Early Childhood Special Education Teacher Mary Lundeen. Photo submitted

“I was at the point where I thought we couldn’t fix our problems,” Oberbroeckling, a St. Francis resident, said. “There was a good six months I didn’t want to be Nolan’s mom anymore. Many nights we both cried ourselves to sleep.”

Oberbroeckling was having a hard time with her son who would throw temper tantrums and whine. Communicating with Nolan was also difficult; he hadn’t started to speak. While Nolan showed symptoms of Asperger’s, testing found this wasn’t the issue.

Michael and Heather Lott of Andover also had trouble with their son, Tyler. As with Nolan, at two years old, Tyler wasn’t speaking. His mother said he was a “very frustrated little boy.” Tyler went through a lot of testing. While autism and Asperger’s were ruled out, it was discovered he had an IQ of almost 130, a number in the superior range.

Tyler eventually began to speak. While his parents hoped that as his language progressed, his behavior would improve, it didn’t.

“Michael and I could not discipline Tyler,” Heather Lott said. “We couldn’t go out to dinner, to the grocery store or to other people’s houses with him. As he turned five and was getting ready to start kindergarten, we had a lot of concerns about him being in a school setting.”

Both families were put in touch with Mary Lundeen, an early childhood special education teacher for Anoka-Hennepin’s Early Intervention Program, Lundeen has worked with PCIT for the past three years. It is an intervention for children ages two to seven with behavior problems including aggression, non-compliance, defiance, temper tantrums, oppositional deviant disorder and attention deficit hyperactivity disorder (ADHD). Twenty people in the state are trained in PCIT; Anoka-Hennepin is the only school district to offer the program.

Once they enter the program, parents and their children have a one-hour session a week with Lundeen, who is a licensed psychologist, for four to five months. Parents are also asked to do five minutes of homework per day. Through PCIT, parents work to develop new interactions with their child. Parents do not pay for the service; it is part of their child’s individual education plan.

• Praise, parents tell their children exactly what they like which will increase the behavior being praised.

• Reflect, repeats or paraphrase what the child is saying to demonstrate understanding and acceptance.

• Imitate, copying what a child is doing shows the child the parent approves of his or her actions.

• Describe, behavior descriptions say what the child is doing and shows an interest in the child.

• Enthusiasm, means a parent can act happy and natural when spending time with his or her child.

Following the positive strategies, a parent directed procedure for following directives and using a brief time out is taught.

“Don’t” rules include:

• Commands, this takes the lead away from the child.

• Questions, calls on a child to give an answer and many times are commands that require an answer.

• Criticism and sarcasm, which express disapproval of the child.

CDI’s rules include how to handle problems. Parents are instructed to ignore minor misbehavior by looking away or showing no expression to the child. This helps a child to notice the difference between responses to good and bad behavior. According to CDI, although the ignored behavior may get worse at first, consistent ignoring reduces attention-seeking behavior. CDI recommends stopping playtime when there is aggressive or destructive behavior. These behaviors cannot be ignored because they can be dangerous.

During a session, Lundeen used a video system to observe Oberbroeckling and her child at play. She gave Oberbroeckling feedback through an ear piece she was wearing and tracked the number of times the mother followed the skills set out in the CDI rules. The goal is to see one of the skills, such as labeled praise, every 10 seconds.

After the observation, Lundeen gave Oberbroeckling her feedback. Though Lundeen hadn’t worked with Oberbroeckling since summer, Lundeen said the mother’s skills were “right up there.”

“After listening for the first minute I realized I didn’t have to coach you,” Lundeen told Oberbroeckling. “You gave Nolan commands and he followed them. You did a great job of praising him. He’s calm, happy and loves to play with you.”

In addition to working with children and families at a school district facility, Lundeen also goes with the parent and child into a public setting, such as shopping, and visits to the child’s day care.

“When children can self-regulate and see adults as caring, safe and predictable, the whole world opens up to them,” Lundeen said. “They won’t walk into someplace and start to throw things or cry. They come to rely on adults and they can do well with new people.”

Having spent her career as a special education teacher, four years ago Lundeen took a sabbatical to study infant mental health, a new and growing field. A study in 2000 found that “low levels of maternal responsiveness and parent-child affection between mothers and infants as young as six months were associated with both parent- and self-reports of aggressive behavior at 17 years.”

Lundeen said if parents and a child are a mismatch, it’s important to spend the time to show them how to interact. In addition to helping families, this work with young children will save the school district money in the long run. If mental health and behavior problems can be addressed and special education services avoided, the district can save $15,000 a year per student in early childhood special education services and $7,000 a year per student in elementary school special education services.

In the past three years, Lundeen has worked with between 30 and 40 families. When asked what she likes best about her work, Lundeen responds with “what don’t I like?”

“This empowers parents to be the best they can be,” Lundeen said. “By the end of our work parents feel they can handle their children. I know that the parent and child will be linked forever in a good relationship. The little person has the chance to grow and change that he or she wouldn’t have had before. It’s a great feeling.”

Lundeen credits Superintendent Dennis Carlson, Special Education Director Mary Clarkson, Community Education Director Steve Kerr and early childhood special education supervisors Jane Roundtree and Pamela Tarasar for their support. She said it takes a visionary district to look at the relationship between a parent and a child and see the long-term impact it has.

“The more work we do with younger kids, the better chance we have to forever changes things,” Lundeen said. “It’s nice to be in a district that allows us to do this.”

Lundeen’s work with the Lotts and Oberbroeckling has had a long-term impact on their families.

When Heather Lott told her husband about Lundeen’s work, he had to be convinced this would be a good thing to pursue.

“I was skeptical because of how severe his behavior was,” Michael Lott said. “I didn’t think anything would work.”

Through PCIT, the parents learned the importance of consistency and defined purpose.

“It was an eye opener to be made aware of the use of empty threats and the importance of being consistent,” Heather Lott said. “And in the midst of chaos and uncertainty, we found a defined process for dealing with Tyler. I had sayings posted on our cupboards on how to give positive feedback and directives.”

“We try to compliment Tyler all the time,” Michael Lott said. “If he does something wrong, we say, ‘That’s inappropriate and this is why.’ We constantly work with him.”

Now the Lotts’ son, who once needed more than an hour in a “time out room” because he could not sit in his time out chair without throwing it, is doing well at his elementary school. Students in his first-grade class get to pick something out of a treasure chest for good behavior. Recently, Tyler did not get to pick an item.

“I asked him why and he said he wasn’t good enough,” Michael Lott said. “He was great about it; he didn’t dwell on it. He knows if he was naughty he won’t get something and he’ll try again next week.

“Last year in kindergarten if he didn’t get a purple dragon for good behavior he would cry. Some days they would have to carry him onto the bus because he didn’t want to come home and tell us he didn’t get a purple dragon. Now we don’t have to constantly reward him.”

“Tyler now realizes he is expected to follow the rules,” Heather Lott said. “He wants to do well. He wants to be like his peers in his class, he doesn’t want to be an embarrassment.”

And this year Tyler is making friends.

“He has friends who want to be his friend; that was not the case in kindergarten,” Heather Lott said. “He sits with friends at lunch and can list boys and girls who are his friends. Now we are just waiting for him to be invited to a birthday party.”

Oberbroeckling began her work with Lundeen thinking she had “nothing to lose.” Within the first two weeks of the program she noticed a “big difference” in Nolan’s behavior. Months later the mother and son who “didn’t understand each other” are on the right track.

“We didn’t have that initial bonding moment,” Oberbroeckling said. “It was in part because of his disabilities, but it was part me, too. Now we’ve figured each other out and had that bonding moment we needed.

“If it wasn’t for Mary, I don’t know where I would be. I probably wouldn’t be Nolan’s mother, any more. And now I wouldn’t trade him for the world.”